Adult Day Health Rehab Services Prior Authorization Form
Friday, April 7, 2017
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Disabilities, Aging and Independent Living
Adult Services Division
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Angela Smith-Dieng, Division Director
HC 2 South, 280 State Drive
Waterbury, VT 05671-2070
Voice: (802) 241-0294
Fax: (802) 241-0385
For Telecommunications Relay Service: Dial 711
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Limited English Proficiency (LEP)
This is a Division of the
Department of Disabilities, Aging and Independent Living
under the Agency of Human Services